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also characteristic of dissociation. A considerable amount of ambiguity surrounds his use of this phrase. As he truly says, "the subject of a fugue is certainly not unconscious,” but his consciousness during the fugue is "cut off or dissociated from the consciousness of the normal waking life.” In this sense it may be said that the “independent activity' carries with it ‘independent consciousness,' and Dr Rivers contrasts this with what occurs in claustrophobia, where the unconscious experience, though active, gives no evidence of independent conscious existence. He then goes on to say: “It is wholly out of place to speak of the unconscious or of unconsciousness in the case of a fugue, and Dr Morton Prince has suggested that we shall use the terms 'co-conscious' and “co-consciousness' rather than ‘unconscious' and ‘unconsciousness.

I cannot help thinking that Dr Rivers here shows some misunderstanding of Dr Morton Prince's use of these terms-or, at least, that his reference to them may lead to misunderstanding in the minds of some of his readers. I do not think Dr Morton Prince would ever apply the term “co-consciousness' to the consciousness manifested by a patient during a fugue. Whether or not he would consider the 'fugue-complex' to be co-conscious when the patient comes back to his normal state, is another matter. I believe he would agree with Dr Rivers that "in an ordinary fugue we have no evidence of such co-existence of independent consciousness. Nor is it correct to say that these terms are especially appropriate to the examples of double or multiple personality such as that of Dr Prince's patient Miss Beauchamp; for only one of the personalities in this case, namely B iii (Sally), was co-conscious. When, therefore, Dr Rivers tells us that he does not propose to adopt Dr Morton Prince's terms for the more ordinary cases of dissociation, we must reply: “Neither does Dr Prince."

În choosing the term “alternate consciousness' to indicate the kind of independent consciousness shown in fugues, Dr Rivers is hardly introducing anything new into psychopathology. This term has been used for many years exactly in the sense in which it is used in this book, namely, to denote a phase of consciousness which alternates with the normal waking consciousness or with other secondary states.

Many years ago?, in attempting to classify cases of multiple personality, and, incidentally, all instances of mental dissociation, I tried to divide them into two great groups which I called the ‘simply alternating' and the “coconscious' types. (It is necessary to qualify the word 'alternating' in this way because co-conscious personalities may alternate also. The true distinction lies in the presence or absence of co-consciousness.) In the simply alternating type there is reciprocal amnesia between the two states, and the one state does not ‘know' the other,--A does not know B, and B does not know A. In the co-conscious type amnesia is in one direction only,-A does not know B, but B does know A, and when B comes as an alternating personality it remembers all that A has said or done.

Since a true co-consciousness—the existence of which, in some cases, Dr Rivers admits--is obviously an 'independent consciousness,' it would have led to greater clearness in his exposition if he had reserved the term 'alternate' for such independent consciousness as is exhibited in fugue (my simply alternating type) instead of using, as he does, 'alternate' and 'inde pendent'indifferently, as if they were synonymous.

1 Proceedings Soc. Poy. Res. 1912, Vol. XXVI, p. 257.

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Dr Rivers' purpose apparently is so to define dissociation that it may easily fit into his biological theory of the neuroses. He states very clearly his conclusion regarding its nature, on p. 79. He there says: “The term 'dissociation' will then be used for a process of activity of suppressed experience in which this activity is accompanied by consciousness so separated from the general body of consciousness that the experience of each phase is inaccessible to the other under ordinary conditions, in which the two phases can only be brought into relation with one another by means similar to those by which experience can be recovered from the unconscious.” Such a definition would exclude co-conscious personalities from the category of dissociation; for in these cases it cannot be said that each phase is inaccessible to the other under ordinary conditions. And if co-conscious personalities are excluded, then hypnotic states must be excluded, for the relation between a co-conscious . personality and the normal waking self, in regard to the accessibility of the experience of each phase to the other, is precisely the same as that between the hypnotic and the waking state. Yet we find Dr Rivers saying, on p. 102, that "hypnotism affords a characteristic example of dissociation.”

To say that “the hypnotic state only differs from... a fugue in having been produced by the suggestion of another person” is to misrepresent entirely the nature of fugue states. In a typical fugue there is that reciprocal amnesia between the two phases which characterises the simply alternating type of double personality, while between the hypnotic state and the waking state the amnesia is always one-sided. The memory in the hypnotic state includes the events both of hypnosis and of waking life.

In speaking of post-hypnotic suggestions Dr Rivers is constrained to suppose that in some cases their fulfilment may be accompanied by co-consciousness, and he says that this hypothesis would naturally lead us to an interpretation of the fugue on similar lines; that "it would lead us towards, if not to, the view that in a fugue the normal consciousness is there underlying the split-off consciousness accompanying the activity of the fugue.” But does anyone suppose that during hypnosis the normal consciousness is there underlying the split-off consciousness accompanying the activity of the hypnotic state? What is sometimes asserted is, that in the waking life of a trained hypnotic somnambule the ‘hypnotic personality' may persist, and be aroused to function as a co-consciousness, -as an independent stream of consciousness concurrent with the consciousness of the waking self. The true parallel in fugue would be to suppose that in the normal state of the patient the split-off consciousness of the 'fugue personality is there underlying the normal consciousness. But while there is good evidence of such a possibility in the case of trained hypnotic subjects, there is no evidence, so far as I know, in favour of the view that such co-consciousness ever obtains in cases of fugue.

Thus, although Dr Rivers' definition of dissociation would seem to exclude co-conscious personalities (because here the experience of one phase is accessible to the other), he is evidently prepared to admit them among the dissociations provided that they alternate. It would also seem that when he speaks of independent' consciousness, he has in mind only 'alternate' consciousness, and disregards or disbelieves in the 'independence of co-conscious states. It is because hypnosis is an alternate phase of consciousness that he regards it as independent, and includes it among the dissociations; but, as has been pointed out, the fact that the experience of the normal phase is accessible to the hypnotic phase should, by his definition, exclude it. It would, therefore,

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seem that either his definition is faulty, or hypnotism should not be called a dissociation.

Seeing, however, that hypnotism is included among the dissociations, we are surprised to find that hysteria is excluded. He says that “if... we hold independent consciousness to be a necessary part of the concept of dissociation it is evident that hysteria wholly fails to answer to the definition, for there is no evidence whatever of such independent consciousness. In the absence of any evidence of alternate consciousness, it is doubtful if anything is gained by bringing hysteria within the category of dissociation. I have therefore no hesitation in excluding dissociation from the connotation of hysteria” (p. 134). He admits the close relation of hysteria to hypnotism, but he thinks it differs from hypnotism "in being unaccompanied by independent consciousness."

In speaking thus of hysteria Dr Rivers seems to have in mind only symptoms like anaesthesia and paralysis, for such hysterical manifestations as monoideic somnambulism, for example, present in striking form the characteristics of independence and alternation which he desiderates for dissociation. And even in anaesthesia the presence of “subconscious' sensations, which Janet so clearly demonstrated,

-sensations which Dr Morton Prince would call co-conscious,--is enough to justify us in speaking here of 'independent' consciousness. It has been so frequently insisted-and on very good grounds—that the phenomena of hypnotism and the phenomena of hysteria are indistinguishable, that it is difficult to understand, if this be so, how the former are examples of dissociation while the latter are not.

It is the biological significance which he sees in the process of dissociation as defined by him that makes it necessary for Dr Rivers so greatly to restrict the concept of dissociation. He seeks to show that there has been some biological need to account for the presence of dissociation among the potentialities of human behaviour. He points to the necessity, in such amphibians as the frog and the newt, for the suppression of the memories of one phase of their existence when the other phase is entered upon. “It is essential to the comfort, if not to the existence, of the frog that it shall not be disturbed by the memories of its experience as a tadpole." As early, then, as the amphibian phase of man's evolution the mechanism of dissociation was already present. In morbid states early instinctive modes of reaction tend to reappear, and the occurrence of dissociation under morbid conditions is an example of such a regression.

This is Dr Rivers' explanation of the mechanism of hysteria. He regards it as "a state dependent on the coming into activity, in a modified form, of a mode of reaction which dates back to a very early stage of animal development.” It is a regression to one of the modes of reaction shown by animals when confronted by danger, namely, the reaction of ‘immobility. The paralyses and anaesthesias of hysteria are partial manifestations of a process which, if it were complete, would produce immobility and insensibility of the whole body. In the war-neuroses the conflict between the danger-instincts and the call of duty is solved by a modified form of the “reaction of immobility,” which brings about bodily states that unfit the soldier for further participation in warfare.

Dr Rivers seems to accept Babinski's view of the importance of suggestion in the production of hysteris, and, indeed, he has proposed suggestion neurosis? as an appropriate term for the state. Primarily, however, he regards it as

being due to the activity of a danger-instinct - an instinct whose primary function is protection from danger. For this reason he now prefers to call hysteria substitution neurosis.'

Dr Rivers sees that if his view of the nature of hysteria is sound, it ought to be possible to show that it holds good not only for the neuroses of warfare, but also for hysteria as we know it in civil practice. He admits that his own experience in this field is too small to enable him to deal adequately with this problem; but, even in the brief consideration he gives to it, he finds the difficulties so great that he is inclined to believe that the hysteria of peace and the hysteria of war are “two distinct varieties of hysteria,” the two differing in the nature of their aetiology.

It is hardly possible to examine here Dr Rivers' application of his biological theory to the neuroses as a whole. Restricted in his experience, as he admittedly was, to the psycho-neuroses of war, he escapes many of the problems which are presented by the more complex conditions of the peace or civil neuroses. He admits the similarity of the mechanisms in both cases, but the importance he ascribes to the danger-instincts and his insistence on their sufficiency to produce the symptoms of hysteria and other neuroses, run counter, on almost every page, to that body of knowledge which psychoanalysis has built up in the course of many years of investigation of the neuroses and psychoses of civil life. Nevertheless, Dr Rivers' contributions to the problems of nervous and mental disorders are of great interest, and his endeavour to give them a biological setting is a legitimate application of that principle of continuity which should ever dominate the pursuit of the biological sciences.

T. W. MITCHELL.

174

REVIEWS.

The Croonian Lectures on the Psychology of the Special Senses and their Functional

Disorders. By ARTHUR F. HURST, M.A., M.D., F.R.C.P. London: Henry
Frowde, Hodder and Stoughton, 1920. pp. x + 122.

The Croonian Lectures delivered this summer before the Royal College of Physicians are here published in full with additional case-records. They are devoted to a description and an interpretation of some of those symptoms which are manifestations of the psychical disorder often termed Hysteria,' a label which Dr Hurst adopts because of its ancient usage.

He defines an hysterical symptom as one " which has been produced by suggestion and is curable by psychotherapy," and hysteria as a condition in which such symptoms are present. That suggestion is perhaps an essential factor in the production of hysterical symptomis no one will gainsay. But such a definition does not take into account the variable suggestibility of different individuals or of the same individual on different occasions. Dr Hurst believes that“ given a sufficiently powerful suggestion, there are probably no individuals who would not develop hysterical symptoms.” But there are surely other variables than the strength of stimulus. It would seem evident that in any attempt to arrive at an adequate explanation of the occurrence of hysterical phenomena it is necessary to take into consideration not only the strength and nature of the suggestion but also the psychological situation of the individual before, during and after the presentation of the suggestion. Within the province of the enquiry should also be included the question as to whether hysterical manifestations show any trace of unconscious aim or purpose and the cause of their perpetuation in the absence of treatment.

Dr Hurst is of opinion that the patient who is suffering from blindness or deafness of psychogenic origin fails to see or hear because he is inattentive to visual or auditory impressions. One gathers from his book that he considers this process to be a passive one, a view which is in direct opposition to the findings of most investigators. In this connection mention may be made of the comparative freedoin from anxiety and emotional distress in many patients with sensory or motor disturbances of psychical origin who before the appearance of the somatic disorders were depressed and worried. This observation which has been made by many psychologists seems to have escaped the attention of the author but it is one of some significance. Further no comment is made on the absence of paralysis and anaesthesia in so large a number of those cases of psychoneurosis in which anxiety forms a prominent symptom.

In his description of cutaneous, auditory and visual sensibility and certain associated motor and reflex disturbances the author has presented much interesting material. He brings forward a mass of evidence to show that the so-called mental and physical stigmata in hysterical subjects are the result of suggestion on the part of the investigator and so far as the physical manifestations are concerned his findings are most striking. Of especial interest are his observations on the efficiency of the tests commonly used for diagnosis in cases of deafness. He clearly demonstrates the uselessness of the tests usually employed to distinguish complete deafness of psychical origin from that due to structural changes in the auditory apparatus. In both groups of cases there

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